Do Runners Even Need Toenails, Anyway?

Every workplace has its own unique morning-meeting culture. At Goldman Sachs, traders surely share their latest billion-dollar victories. At Vogue, editors outline next season's denim-on-denim-on-denim trend. And here at Runner’s World, we talk about toenails. Lost toenails. Missing toenails. Gone-but-not-forgotten toenails. And amid all these black-and-blue sob stories, we began to wonder, do runners even need toenails? What do thin little slabs of alpha-keratin do, anyway? It was time to seek answers.

So, first things first: Why do runners' toenails tend to fall off? Basically, said Allan Rothschild, D.P.M., a podiatrist in Dunedin, Florida, who has been treating Tampa Bay area runners of all ages for years, it's all that running.

Rothschild explained that during the push-off phase of your gait, when one foot is behind you and the other one is striking the ground, the toes on your trailing foot are extended up. When these toes are hyperextended, they hit the toe box of your shoe. Even though your shoe is relatively soft, that contact is a microtrauma. When you’re running five to ten miles per day, or even more in a half or full marathon, and those microtraumas can add up.

“Runners can experience discolored nails, which is a collection of blood beneath the nail plate (subungual hematoma) as a result of microtrauma to the toe against the ‘shoe box,’” Rothschild said.

The bleeding can in turn cause the nail plate to separate from the nail bed and—yup—fall off. Merely losing a toenail is not cause for panic.

“If you’re a runner, you develop a hematoma underneath the nail plate, and the nail falls off, you’re going to grow another nail back normally after,” Rothschild says. “It’s a vicious cycle—it might happen again in six months.”

(Still, if you're losing toenails all the time, you might want to make sure you're wearing shoes that fit your feet properly. A good pair should give your toes plenty of microtrauma-free room to move around. Even with correct footwear, though, sometimes a lost toenail is unavoidable.)

So, if we lose our toenails only to grow them back only to lose them again in six months, what’s the point of having them to begin with? Well, the answer has a lot to do with ancestry and human evolution.

“Toenails are vestigial, and at one time in our ancestral tree they were necessary for defense, digging, climbing, and were used as tools,” Rothschild says. “Fingernails have some practical use in everyday life, such as peeling fruit or scratching, but we don’t use toenails anymore. Ultimately, they’re now there for cosmetic reasons. If you’re a woman and you go out and dress up, you probably have nail polish on.”

That toenails are now purely cosmetic is a point of view that not everyone agrees with.

“Toenails serve a purpose in protecting the tip of your toe and protecting the blood vessels and nerves at the tip of the toe,” said John Krebsbach, D.P.M., a podiatrist in Milwaukee, Wisconsin. (Actually, he's my podiatrist!) Imagine dropping a rock on your foot. Would you rather have the meager protection of a toenail, or none at all? (Please, don't drop a rock on your foot to test this!)

Regardless of their differing opinions on toenail functionality today, both podiatrists agreed: Toenails don't do anything to make you run better. And at the same time, not having them doesn't make you run any worse. They don't really matter.

What's more, they agreed that, if deformed and thickened, toenails can do more harm than good. If this is you, it's time to see the doctor to develop a plan for healthy toenails. There are a couple of ways to remedy this. A podiatrist could trim down or file down the nails. She could give you a topical medication, or an oral medication to deal with infection or fungus. As a last resort, the problematic toenail can be removed with a laser or a chemical.

Just because surgery is a last resort doesn’t mean it’s uncommon. Both doctors have performed thousands of these painless removals on their patients, including many runners. Even so, it would be easy to freak out after your toenail is permanently removed, especially when the sport relies so heavily on your two feet. Nailless feet are atypical and potentially a little bit gruesome. Besides, you want your toenails to look the best they can.

Which one looks more normal? A before and after shot from a toenail removal procedure.

Allan Rothschild, D.P.M.

“I’ve treated thousands and thousands of patients who have that look in their eyes and say, ‘Well, don’t I need it for protection?’” Rothschild says. “The skin grows back after the nail is removed, and tougher, like it does on your heel. It is not sensitive, and you will be able to run pain-free. If patients are worried about look, they can put nail polish on it, similar to when you have your eyebrows plucked and draw them in with an eyebrow pencil. The nail bed is clear, so no one can even tell you are missing a toenail from far away.”

Krebsbach doesn’t completely agree.

“In some individuals, once the nail is gone, the skin and fat pad at the tip of the toes thins or recedes, leaving the bone at the tip of the toe vulnerable and at times painful to touch and irritable to shoe pressure,” Krebsbach says. “Others can live comfortably and continue active lifestyles—including running—without issues.”

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